The Medicare Mess

Yesterday, I documented how the nation’s fixation with “soaking the rich” is not only bad economics but bad public policy. To recap briefly, those who are better off are already providing the federal treasury with far more than their share. The top 400 earners comprise less than 1% of the population, yet their taxes provide more than 2% of total take – while some 45% of Americans don’t pay any income tax. The best way to improve the revenue side of the fiscal equation is to get those 45% to start paying their taxes again.

Of course, we all know that we can’t tax our way out of the debt hole. It’s too deep and deepening every second; even if we close all the tax loopholes and get those 45% to ante up we still won’t close the projected budget deficits for any year over the next ten. Spending needs cutting, although liberals are typically offended by that notion. But it’s the 800 pound gorilla in the room and finally people are noticing.

While the Washingtonians had their fun earlier with whittling away at discretionary spending, the fact is that chopping away at 12% of the annual budget isn’t going to make enough of a difference. (And the reality is, they chopped very little – about $352 million according to CBO). To really tackle our deficit – which needs to be done before we get to paying down the debt – we have to tackle entitlements.

The President’s seriousness about tackling entitlement spending was summed up by this line from his April 13th speech:

“We don’t have to choose between a future of spiraling debt and one where we forfeit investments in our people and our country. To meet our fiscal challenge, we will need to make reforms. We will all need to make sacrifices. But we do not have to sacrifice the America we believe in. And as long as I’m President, we won’t.“

Gee, Mr. President. Sure glad you reiterated for us your commitment to maintaining the status quo.

The small part of the speech he did dedicate to his Medicare reformation plan was filled with smoke and mirrors. There weren’t any concrete details, only a pledge to reduce Medicare costs by $500 billion over the next 12 years. In case you’re wondering, that is less than $45 billion per year – or less than the budget cuts enacted this year. Talk about fiddling while Rome burns! To accomplish that meager goal, the administration proposes to focus on cutting waste and fraud – laudable goals and an admission that the government is doing a terrible job at administering the program. If there is $45 billion in abuse, somebody needs to be fired. The rest is the smoke and mirrors part – relying on the IPAB to force reductions in payments. Grandma will certainly be happy when her doctor tells he can’t see her anymore because the government won’t pay him enough to make it worth his while.

The Republican plan put forth by Paul Ryan kicks the can down the road for another 10 years, then applies an indexed government co-payment to a private plan. While that does provide some cost certainty in the future, it does nothing to address the spiraling debt created today by the program. It also does absolutely nothing to address the cost inflation in health care. In short, it’s more smoke and mirrors accounting.

So if both plans are nothing more than speaking points and fall well short of actually tackling the problem of entitlements, where do we go from here?

The answer is to address the very idea of government entitlements. The very word “entitlement” means that a right to a specific benefit is granted by…somebody. What’s more, expectation of entitlements are often tied to narcissistic attitudes. If you don’t think the two are related, consider what your visceral reaction is to the idea that entitlements need to be cut: odds are that like most people in the Western world, you recoiled at the thought. What, take away my benefits?

The President danced around this very issue in his speech. Namely, what kind of society do we want to be and where do we to place our priorities? The President, along with most liberals, envision a society in which regardless of circumstance you will always be taken care of. To enable this vision, they propose that the productive members of society take care of the unproductive – the misfortunate, as the termed it. Most Republicans also think entitlements are just dandy, although they would prefer the private sector pony up to those responsibilities. In other words, they’re perfectly happy to let businesses handle society’s ills. Anyone who has ever read Dickens can tell you what kind of world that is.

It seems like a horrible quandary, doesn’t it? On the one hand, we’re faced with the prospect of a federal takeover of society; on the other, a return to Merry Olde England of the 1850’s. But there is another way – one that Americans throughout our history relied upon.